Systems and methods for providing sensory feedback during exercise

ABSTRACT

Devices and methods for providing sensory feedback during an exercise are disclosed. An exertion target is set, for a user performing the exercise, based on a self-calibration that estimates the user&#39;s ability using signal amplitudes of surface electromyography (sEMG) data, wherein the exertion target includes a target signal amplitude of muscle contractions to be reached during the exercise. sEMG data are received from a measurement device attached to the user as the user performs the exercise. Upon processing the sEMG data, sensory feedback is generated at a computing device operated by the user, wherein the sensory feedback has an intensity proportional to the user&#39;s exertion level as the user performs the exercise, and wherein the sensory feedback changes over a course of the exercise in dependence on a duration that the user maintains a muscle contraction at or above the target signal amplitude, and the change in sensory feedback is configured to encourage the user to prolong the duration.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.15/313,892, having a 35 U.S.C. 371(c) date of Nov. 23, 2016, which isthe National Stage of International Patent Application No.PCT/CA2015/000342, filed May 22, 2015, which claims priority to U.S.Provisional Patent Application No. 62/002,833 filed May 24, 2014. Thisapplication claims all benefit including priority to each of theforegoing patent applications, the entire contents of each of which arehereby incorporated by reference herein.

TECHNICAL FIELD

This disclosure relates to systems and methods for diagnosing andtreating muscle-related disorders also such as dysphagia and moreparticularly to providing a device that may be used to diagnose andtreat such disorders.

BACKGROUND

Swallowing disorders (e.g., dysphagia) are serious medical conditionsthat have detrimental effects to the mental and physical well-being ofindividuals. Swallowing impairments can lead to serious health problems,such as malnutrition and aspiration pneumonia, as well as psychosocialconcerns and poor quality of life.

Limited clinical capacity and service-delivery models that requireclinician-supervised therapy imply that patients receive potentiallysub-optimal treatment or, even worse, no treatment at all. Furthermore,this limited access to swallowing therapy has resulted in literaturescarcity concerning the relative effectiveness of alternative therapiesand the treatment dose necessary for clinically significantimprovements.

Dysphagia (i.e., difficulty swallowing) affects two in ten Canadiansover the age of 50. Patients with a swallowing impairment often areunable to consume a normal diet, which can lead to dependence orsemi-dependence on tube feeding. This alteration in eating affectssocial interactions, and overall quality of life. The distress andsocial isolation can lead some patients to risk eating foods unsafe forthem to swallow. For some patients, a swallowing impairment can be soserious that it results in significant weight loss and muscle wasting.Furthermore, swallowing impairments are commonly associated withpneumonia because food and oral secretions go down the wrong way andinto the lungs. Pneumonia is a costly condition to treat and can resultin death.

Swallowing therapy, especially that using surface electromyography(“sEMG”) for feedback about what the swallowing muscles are doing, canimprove oral intake, reduce aspiration of food into the lungs, andeliminate the need for a feeding tube. Typical swallowing rehabilitationis based on theories of intensive exercise programs that target specificmuscular structures and sequences of physiologically-based movements,and sEMG biofeedback has been used to monitor muscle activation duringtherapy as well as to train more complex treatment techniques. Oneexercise that has been coupled with sEMG biofeedback, the Mendelsohnmaneuver, involves the volitional prolongation of a swallow, addressinglaryngeal elevation and cricopharyngeal opening. When using sEMGbiofeedback with the Mendelsohn maneuver, clinicians can setsignal-amplitude goals (targeting muscle activation and force) andsignal-duration goals (targeting duration of muscle contraction). WhilesEMG has been the main technology used for biofeedback in swallowingdisorders, another technology, mechanomyography (“MMG”), may be a viablealternative to sEMG. In some embodiments, MMG can make use of a sensorcapable of measuring mechanical oscillations originating from musclecontractions to sense muscle contractions. It some embodiments, suchsensors can comprise a microphone. MMG has been used as a measurementtechnique for many physiotherapy applications that monitor thecontraction of large muscle groups in the legs or arms. While reports inthe literature are few to support its use for swallowing, those that doexist suggest that MMG may be sensitive enough to monitor movement insmall muscles groups such as those in the submental area that contractduring swallowing.

More than a decade ago, sEMG biofeedback technologies for treatingswallowing disorders were brought into the clinical mainstream whenKayPentax™, a leading developer of speech and swallowing therapyinstrumentation, introduced a clinician friendly version. Since thattime, the KayPentax™ system has been used both as a clinical andresearch sEMG tool. However, the system costs may make it inaccessibleto many clinical units. Furthermore, it is not transportable to apatient's home and only works with the packaged computer and operatingsystem.

In addition to using the KayPentax™ system, speech pathologists involvedin sEMG swallowing research have either devised their own hardware orfound other options, such as the Sys/3 4-channel computer-based EMGsystem from NeuroDyne™ Medical, Cambridge™ MA™ or ADInstruments™.ADInstruments™ provides a wireless system (PowerLab™ hardware andLabChart™ software), which is used to record and analyze sEMG signals.This technology, although wireless, is still costly and requirestraining to set up and use. The sensors themselves are larger than thesEMG adhesive pad used with the KayPentax™ system described above (37mm×26 mm×15 mm) and weigh 14.7 g. Although these systems may be morecost-effective than the KayPentax™ system, it is unlikely that thetypical speech-language pathologist has access to biomedical engineerswho can provide the necessary engineering and computer-programmingsupport for these systems to be functional. Therefore, few optionsremain for the typical clinician.

Dr. Catriona Steele, speech pathologist in the Swallowing RehabilitationResearch Laboratory at the Toronto Rehabilitation Institute, has triedto meet the need for inexpensive alternatives by developing software(BioGraph Infiniti™, Thought Technology™, Montreal) that can be pairedwith existing sEMG hardware (MyoTrac Infiniti™, Thought Technology™,Montreal). The device is still relatively large (61 mm×112 mm×25 mm) andweighs 71 g. Further, in order to use this equipment, clinicians areencouraged to take a fee-based course through the Biofeedback Foundationof Europe, which leads them through a standardized swallow treatmentprotocol progressing from regular swallow tasks to those involving theMendelsohn Maneuver. Although this option may provide clinicians with amore cost-effective option, it does not address concerns related toaccessibility of treatment, especially in the home environment with anengaging interface. Furthermore, the current technologies produce highlycomplex data that are not meaningful to the patient, affecting theirmotivation and engagement. Finally, data output for the clinician is notautomated, requiring manual translation of data points.

Thus, swallowing therapy with the use of sEMG may be scarce due to thecost of the existing equipment, lack of equipment portability and taxedclinician availability. Furthermore, swallowing treatment occurring at aclinic does not happen as often as it should because: 1) there are notenough clinicians to meet the demand; 2) current treatment technology iscostly and not readily available in many clinics; and 3) many patientslive in remote areas, limiting access to major rehabilitation centers.In the current Albertan population, approximately 1.1 million people areover the age of 50, meaning that more than 220,000 Albertans areaffected by a swallowing disorder. Unfortunately, the current workforceof just over 1,000 speech-language pathologists in Alberta is notsufficient to treat this population using conventional rehabilitation.On top of the aging population, patients prefer to remain home as muchas possible, or simply cannot travel to treatment centers, calling forremote provision of treatment and management of chronic health issues,such as dysphagia.

In addition to the systems described above, Dysphagia iOS™ Applicationsare currently available. iSwallow™ and Swallow Now™ are iOS™applications intended to be used by patients outside a clinic. iSwallow™allows the clinician to create a personalized treatment regimen byselecting from a set of swallowing exercises. While the applicationprovides patients with video instructions for various swallowingexercises, it is not coupled with sEMG biofeedback. One problem witheHealth applications (and more generally, at-home regimens), such asiSwallow™ is adherence; namely, accurately recording the patient'scommitment to the regime and/or use of the application at home. Patientadherence to a treatment regimen is an important factor in improvinghealth outcomes, but simply tracking patient activity does not ensure,or even motivate, adherence. The example devices described herein mayuse game concepts and design principles to motivate patients to usemaximal effort in practice and to adhere to the complete treatmentregimen.

It is, therefore, desirable to provide a system that overcomes theshortcomings of the prior art.

SUMMARY

Broadly stated, in some embodiments, there is provided a method ofproviding sensory feedback during an exercise, the method including:setting an exertion target, for a user performing the exercise, based ona self-calibration that estimates the user's ability using signalamplitudes of surface electromyography (sEMG) data, wherein the exertiontarget includes a target signal amplitude of muscle contractions to bereached during the exercise; receiving sEMG data from a measurementdevice attached to the user as the user performs the exercise; and uponprocessing the sEMG data, generating sensory feedback at a computingdevice operated by the user, wherein the sensory feedback has anintensity proportional to the user's exertion level as the user performsthe exercise, and wherein the sensory feedback changes over a course ofthe exercise in dependence on a duration that the user maintains amuscle contraction at or above the target signal amplitude, and thechange in sensory feedback is configured to encourage the user toprolong the duration.

Broadly stated, in some embodiments, the sensory feedback is responsiveto the duration that a muscle contraction is maintained at or above apre-defined quantum higher than the target signal amplitude.

Broadly stated, in some embodiments, the sensory feedback includesaudible feedback.

Broadly stated, in some embodiments, the sensory feedback includesvisual feedback.

Broadly stated, in some embodiments, the method further includes:generating a graphical user interface for presentation of the visualfeedback.

Broadly stated, in some embodiments, the sensory feedback provides anindication of the muscle contraction to the user.

Broadly stated, in some embodiments, the indication includes anindication of a duration of the muscle contraction.

Broadly stated, in some embodiments the sensory feedback is presented ina form of a game playable by the user.

Broadly stated, in some embodiments, the method further includes:controlling functions of the game based on said processing the sEMGdata.

Broadly stated, in some embodiments, the method further includes:computing an average and a range of the signal amplitudes received forthe self-calibration.

Broadly stated, in some embodiments, the self-calibration estimates thepatient's ability for a particular day to set at least one of theexertion targets for the exercises of the particular day.

Broadly stated, in some embodiments, the self-calibration estimates thepatient's ability for a particular exercise session to set at least oneof the exertion targets for the exercises of the particular exercisesession.

Broadly stated, in some embodiments, there is provided acomputer-implemented device for providing sensory feedback during anexercise, the device including: a communication interface; at least oneprocessor; memory in communication with the at least one processor, andsoftware code stored in the memory, which when executed by the at leastone processor causes the device to: set an exertion target, for a userperforming the exercise, based on a self-calibration that estimates theuser's ability using signal amplitudes of surface electromyography(sEMG) data, wherein the exertion target includes a target signalamplitude of muscle contractions to be reached during the exercise;receive, via the communication interface, sEMG data from a measurementdevice attached to the user as the user performs the exercise; and uponprocessing the sEMG data, generate sensory feedback that has anintensity proportional to the user's exertion level as the user performsthe exercise, and wherein the sensory feedback changes over a course ofthe exercise in dependence on a duration that the user maintains amuscle contraction at or above the target signal amplitude, and thechange in sensory feedback is configured to encourage the user toprolong the duration.

Broadly stated, in some embodiments, the communication interface isconfigured for wireless communication with the measurement device.

Broadly stated, in some embodiments, the wireless communication includesBluetooth communication.

Broadly stated, in some embodiments, the device is a portable computingdevice.

Broadly stated, in some embodiments, there is provided a non-transitorycomputer-readable medium having stored thereon machine interpretableinstructions which, when executed by a processor, cause the processor toperform a computer implemented method for providing sensory feedbackduring an exercise, the method including: setting an exertion target,for a user performing the exercise, based on a self-calibration thatestimates the user's ability using signal amplitudes of surfaceelectromyography (sEMG) data, wherein the exertion target includes atarget signal amplitude of muscle contractions to be reached during theexercise; receiving sEMG data from a measurement device attached to theuser as the user performs the exercise; and upon processing the sEMGdata, generating sensory feedback that has an intensity proportional tothe user's exertion level as the user performs the exercise, and whereinthe sensory feedback changes over a course of the exercise in dependenceon a duration that the user maintains a muscle contraction at or abovethe target signal amplitude, and the change in sensory feedback isconfigured to encourage the user to prolong the duration.

Broadly stated, in some embodiments, a system can be provided for use inthe diagnosis and treatment of a swallowing disorder of a patient, thesystem comprising: a computing device; and a measurement deviceconfigured for attaching to the patient, wherein the measurement deviceis configured to transmit surface electromyography (“sEMG”) ormechanomyography (“MMG”) data to the computing device.

Broadly stated, in some embodiments, the measurement device can furthercomprise a chin attachment configured for attachment to a chin of thepatient.

Broadly stated, in some embodiments, the system can further comprise awearable computing device.

Broadly stated, in some embodiments, the system can further comprise ahousing configured for attachment to a chin of the patient, wherein themeasurement device and the wearable computing device are disposed in thehousing.

Broadly stated, in some embodiments, the wearable computing device canbe configured for amplifying and filtering a sEMG signal derived fromthe sEMG data or a MMG signal derived from the MMG data.

Broadly stated, in some embodiments, the wearable computing device canbe configured for transmitting the sEMG or MMG signal to the computingdevice.

Broadly stated, in some embodiments, the computing device can compriseone or more processors configured for: receiving the sEMG signal or theMMG signal; and generating a graphical user interface based on thereceived sEMG or MMG signal.

Broadly stated, in some embodiments, the graphical user interface can beconfigured for indicating the duration of submental muscle contractionin the patient.

Broadly stated, in some embodiments, the computing device can compriseone or more processors configured for calculating an average and a rangesignal amplitude of the sEMG or MMG signal during a calibration phase.

Broadly stated, in some embodiments, the computing device can compriseone or more processors configured for determining one or more of a groupconsisting of: time of log-in, duration of session, length of time sincelast session, session's target amplitude, type of exercise practiced,number of trials, amplitude for each trial, duration for each trial,average for each type of exercise, duration average for each type ofexercise, and range for each type of exercise.

Broadly stated, in some embodiments, a method can be provided for use inthe diagnosis and treatment of a swallowing disorder of a patient, themethod comprising the steps of: providing the system described above;attaching the measurement device described above to a chin of thepatient; and measuring muscle contraction of the patient when thepatient swallows.

Broadly stated, in some embodiments, the method can further comprise thestep of providing audible or visual feedback to the patient, wherein thefeedback provides an indication of the muscle contraction to thepatient.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1A is a block diagram depicting one embodiment of a system used forthe diagnosis and treatment of swallowing disorders in which the sensorand wearable computing device are separated and connected by a cable.

FIG. 1B is a block diagram depicting another embodiment of the system ofFIG. 1A in which the sensor and wearable computing device are enclosedin the same housing.

FIG. 2A is a top plan view depicting a wearable computing device for usewith the system of FIG. 1 A.

FIG. 2B is an exploded elevation view depicting the wearable computingdevice of FIG. 2A.

FIG. 3A is a top plan view depicting a wearable computing device usewith the system of FIG. 1B.

FIG. 3B is a perspective view depicting the wearable computing device ofFIG. 3A.

FIG. 3C is a front elevation view depicting the wearable computingdevice of FIG. 3A.

FIG. 3D is a rear elevation view depicting the wearable computing deviceof FIG. 3A.

FIG. 4 is an exploded perspective view depicting the wearable computingdevice of FIG. 3A.

FIG. 5 is a perspective view depicting a patient wearing the wearablecomputing device of FIG. 3A.

FIG. 6 is a block diagram depicting an embodiment of a wearablecomputing device for use with the system of FIG. 1A or FIG. 1B.

FIG. 7A is a block diagram depicting one embodiment of a sEMG signalprocessing module for use with the system of FIG. 1A or FIG. 1B.

FIG. 7B is a block diagram depicting one embodiment of a MMG signalprocessing module for use with the system of FIG. 1A or FIG. 1B.

FIG. 7C is a block diagram depicting another embodiment of a sEMG signalprocessing module for use with the system of FIG. 1A or FIG. 1B.

FIG. 8 is a block diagram depicting one embodiment of a computing devicefor use with the system of FIG. 1A or FIG. 1B.

FIG. 9 is a block depicting one embodiment of applications for use withthe computing device of FIG. 8.

DETAILED DESCRIPTION

In general, this disclosure describes a system for use in diagnosing andtreating swallowing disorders.

In some embodiments, the devices described herein, unlike currentin-clinic technology, can be portable and relatively inexpensive and canallow a patient to complete therapy at home, and can allow a clinicianto monitor a patient's activity remotely through access to a datawarehouse and/or an online portal. Further, in some embodiments, unlikecurrent technology, applications described herein can provide meaningfulfeedback to a patient about what their swallowing muscles are doing.This can be done by incorporating game concepts and design, such as goalsetting, patient position relative to goal, creation andpersonalization, connections and ways to share results, practicereminders and progress bars into the application. In some embodiments,de-identified home practice data can be sent instantaneously to acentral server so that the clinician can monitor progress and change thecourse of therapy. In addition, uploaded data can be used to create anevidence-base for this type of treatment that will ultimately guideclinical decision-making. Further, in one example, devices describedherein can incorporate feedback from additional clinicians outside thecore clinical or research group, as well as patients and healthadministrators. The mobile health devices described herein can be usedto: improve quality of life in patients with swallowing difficulties byproviding more consistent, motivating and accessible swallowing therapy;address an unmet clinical need in the health system; and provide aneffective technological solution to reduce the burden of costs onpatients, and the health care system.

FIG. 1A and FIG. 1B are block diagrams illustrating embodiments ofsystems that can implement one or more techniques of this disclosure.System 100 can be configured to treat and diagnose swallowing disordersin accordance with the techniques described herein. System 100 can beconfigured to observe the sEMG or MMG signal of patients practicing theMendelsohn maneuver or other swallowing exercises and through anassociated mobile application motivate, record and analyze individualtrials and sessions and provide feedback to the patient. In someembodiments, the application can comprise a game. In the embodimentillustrated in FIG. 1A, system 100 can comprise measurement device 200,computing device 300, communications network 400, data warehouse andclinician portal 500 and clinical site 600.

Components of system 100 can comprise and be implemented as any of avariety of suitable hardware and software, such as one or moremicroprocessors, microcontrollers, digital signal processors (“DSPs”),application specific integrated circuits (“ASICs”), field programmablegate arrays (“FPGAs”), discrete logic, analog circuitry, software,software modules, hardware, firmware or any combinations thereof as wellknown to those skilled in the art. System 100 can comprise softwaremodules operating on one or more servers. Software modules can be storedin a memory and executed by a processor. Servers can comprise one ormore processors and a plurality of internal and/or external memorydevices. Examples of memory devices can comprise file servers, FTPservers, network attached storage (“NAS”) devices, a local disk drive orany other type of device or storage medium capable of storing data aswell known to those skilled in the art. Storage medium can compriseBlu-ray discs, DVDs, CD-ROMs, flash memory or any other suitable digitalstorage media as well known to those skilled in the art. When thetechniques described herein are implemented partially in software, adevice can store instructions for the software in a suitable,non-transitory computer-readable medium and execute the instructions inhardware using one or more processors.

In some embodiments as illustrated in FIG. 1A, measurement device 200can comprise chin attachment sensor 202 and a wearable computing device206, where chin attachment sensor 202 and wearable computing device 206can be electronically coupled. In some embodiments, a wire can beenclosed in rubber wiring enclosure 204 disposed between sensor 202 anddevice 206. In some embodiments, the length of the wire between chinattachment sensor 202 and wearable computing device 206 can be as shortas possible to reduce signal noise while still allowing some slack formovement. Rubber material encasing the wires can be chosen to protectthe wires and prevent unnecessary bending or fraying. In someembodiments as illustrated in FIG. 1B, measurement device 200 can haveboth the chin attachment sensor 202 and wearable computing device 207contained in the same enclosure so as to remove the requirement forrubber wiring enclosure 204.

FIGS. 2A and 2B illustrate one embodiment of wearable computing device206 that can be used with system 100 as shown in FIG. 1A. In thisembodiment, device 206 can be designed to accommodate users with limitedshoulder range of motion, i.e., the neck-piece may be flexible and notrequire an overhead arm motion. In some embodiments, device 206 cancomprise collar 203 further comprise casing halves 211 and 213 disposedon an end thereof. Casing halves 211 and 213 can enclose printed circuitboard 221 disposed therein, where printed circuit board 221 can comprisethe electronics and functionality, as described in further detail below.In some embodiments, casing halves 211 and 213 can be easily separatedfor repairs as necessary.

Device 206 can further comprise silicone hand grip 215 configured toreleasably attach to casing halves 211 and 213 when assembled together.In some embodiments, device 206 can comprise USB 223 connector disposedon casing half 213 and operatively connected to printed circuit board221 for connecting to an external computing device (not shown). Device206 can also comprise connector jack 225 operatively connected toprinted circuit board 221 for providing a connection between chinattachment 202 and printed circuit board 221. Device 206 can alsocomprise chin attachment 202 configured to house a sEMG sensor or a MMGsensor and to attach to the chin of a patient, wherein chin attachmentsensor 202 is operatively connected to printed circuit board 221 viaelectrical wires or cables disposed in rubber wiring enclosure 204disposed between casing half 213 and chin attachment 202. In someembodiments, chin attachment 202 can be a universal fit device or can becustom-fitted to the patient.

FIGS. 3A to 3D and 4 illustrate one embodiment of wearable computingdevice 207 that can be used with system 100 as shown in Figure IB. Inthis embodiment, sensor 202 and wearable computing device 206 can beincluded in the same enclosure to form device 207. As shown in FIG. 4,the casing for device 207 was designed to be mindful of the challengethat patients might have in aligning the device under the chin. In someembodiments, device 207 can comprise one or both of distinct recesses208 and 209, each recess relating to the location of potential sEMGelectrodes disposed in device 207. In some embodiments, singularcircular recess 208 can be aligned vertically with a referenceelectrode, while longer rounded recess 209 can be vertically alignedwith two active electrodes. This embodiment can provide both a visualand a tactile reference for proper alignment with the required anatomy.Other considerations from the patient's perspective involved referencinghuman factors measurements to ensure the device is appropriate for avariety of hand sizes, grip strengths and motor skills.

In some embodiments, device 207 can comprise top casing half 218,wireless transceiver module 220, battery 222 for providing electricalpower to the electronics disposed in device 207, cradle 224 for housingbattery 222 and module 220, printed circuit board 226, lower casing half228 and sensor pad 230. In some embodiments, transceiver module 220 canbe a Bluetooth™ transceiver. In some embodiments, casing half 218 cancomprise tangs 219 to releasably attach to tang recesses 229 disposed incasing half 228 to enable easy disassembly of device 207 for repairs asnecessary. In some embodiments, lower casing half 228 can compriseslidable button 234 to operate switch 235 disposed on circuit board 226when installed in casing half 228. In some embodiments, lower casinghalf 228 can comprise opening 236 to provide access to electricalconnector 238 disposed on circuit board 226 when installed in casinghalf 226. In some embodiments, sensor pad 230 can comprise electrodes232 for connection to circuit board 226. In some embodiments, casinghalves 218 and 228 can be approximately 50 mm in diameter, and can becomprised of materials that are easy to clean with hospitaldisinfectants, as well known to those skilled in the art.

In some embodiments, the enclosure can be designed to house battery 222,and circuit board 226 that can comprise charging circuitry, analogconditioning circuitry, connection to a plurality of electrodes 232 thatcan further comprise sEMG or MMG sensors, an onboard microcontrollerunit, wireless transceiver module 220 that can comprise a wirelessconnection method such as, but not limited to, Bluetooth™ or Zigbee™,which can be all on one or more printed circuit board(s) 226. In someembodiments, the device can comprise all analog electronics necessaryfor signal acquisition and conditioning, as well as all digitalelectronics necessary for signal digitization and wireless datatransfer. Some embodiments can comprise, located on the housing, abutton or switch to turn the device off and on or indicate some otherfunctionality to the internal electronics such as wake up or to changethe current operational mode. In some embodiments, the device cancomprise one or more indicators 216 which can comprise one or more ofthe following: light emitting diodes, a small screen, an audio indicatorsuch as a speaker or piezo-electric indicator, a vibratory device and ahaptic indicator, all of which can be used to indicate such things aswhether the device is off or on, if it is charging or finished charging,if the wireless module is connected, battery charge level, if the deviceis taking a reading, as well as if the device is properly aligned on theindividual.

Referring to FIG. 5, an embodiment of device 207 is shown attached tochin C of patient P, as an example.

FIG. 6 is a block diagram illustrating an example measurement device 200that can implement one or more techniques of this disclosure.Measurement device 200 can be configured to filter and amplify sEMG orMMG signals, and send those remotely to a mobile device, such as, forexample, computing device 300. As illustrated in FIG. 6, in someembodiments, wearable computing device 206 can comprise includes chinattachment sensor 202, electrode(s) 201, signal processing module 210,microcontroller 217, power supply 212, wireless transceiver 214, andindicators 216. In some embodiments, electrode(s) 201 can comprise threeelectrodes. In other embodiments, electrode(s) 201 can be replaced with,or can further comprise, one or more MMG sensors. In some embodiments,electrodes can be coupled to sEMG adhesive pads. In one example, thesEMG adhesive pads can be light and inexpensive single-use pads that donot require cleaning, or they can comprise a medical-grade reusablesolvent-based or non-solvent based adhesive or a silicon adhesive toprovide for many uses before replacement. In other embodiments, the sEMGpads can all be included in the same adhesive pad to simplify theapplication. In other embodiments, this combined sensor pad cancomprising one or more sEMG or MMG sensors can be connected to theenclosure, and then the enclosure and the sensors can be applied to thepatient's chin together. In other embodiment, the sEMG pad can becoupled with a chin mold housing the leads. Further, the design of thechin mold can make the placement of the pad intuitive, and can furtherprevent incorrect connection of the adhesive pad to the leads. In someembodiments, an MMG sensor can comprise a MEMS microphone and anamplifying chamber created out of a biocompatible plastic or metal. Thediameter of the chamber can have a diameter of approximately 7 mm and aheight of approximately 10 mm. Further, aluminized Mylar™ can be used asthe membrane (having 10 mm diameter) that can cross the amplifyingchamber. In one example, power supply 212 can comprise a lithiumbattery. Further, power supply 212 can comprise USB port 238 or anothercustom connector to allow for the measuring device 200 to be charged.This port can also be used to move collected patient data off of thedevice, download new firmware into the device, and/or perform tests onthe device. Alternatively, the device can be charged by inductionthrough a wireless inductive link. The power supply 212 can also includecircuitry to prevent the use of the system while the device is charging.Signal processing module 210 can be configured to capture and process asignal from electrodes. Wireless transceiver 214 can comprise a wirelesstransmitter that can communicate the captured signal to the mobileapplication for analysis. In one example, wireless transceiver 214 cancomprise a Bluetooth™ transceiver and the transmitted data can compriseserial data. Indicators 216 can comprise one or more light emittingdiodes to indicate an operating mode to a patient. In some embodiments,all of these components can be controlled by a firmware applicationrunning in microcontroller 217.

FIG. 7C is a block diagram illustrating an example sEMG signalprocessing device that can implement one or more techniques of thisdisclosure. As illustrated in FIG. 7C, signal processing device 210 cancomprise some or all of the following: signal acquisition module 250,amplification module 252, bandpass filter 254, rectification module 256and envelope detection module 258. From signal processing device 210,the signal can be digitized by analog to digital converter 253, and thenmicrocontroller 217 can send the digitized signal out throughtransmission interface module 249. In some embodiments, microcontroller217 and analog to digital converter 253 can be disposed on the sameintegrated circuit.

FIG. 7A illustrates an alternative sEMG signal processing device 210that can comprise only high pass filter 255 instead of bandpass filter254, and can further comprise AC Coupling module 257 as well as DCBiasing module 259. In some embodiments, the output signal of signalprocessing device 210 can comprise a smoothed muscle response curve thatis ready for digitization.

FIG. 7B illustrates another embodiment of the system comprising MMGsignal processing device 210, further comprising microphone 251 togather the MMG signal. In some embodiments of device 210 as shown inFIGS. 7A and 7B, high pass filter 255 can comprise a cut-off frequencyof 10 Hz. Referring back to FIG. 7C, in some embodiments, amplificationmodule 252 can comprise an amplification factor of 1000. In someembodiments, bandpass filter 254 can comprise a 10 Hz to 500 Hz bandpassfilter. In some embodiments, rectification module 256 can comprise adiode. In some embodiments, the amplification, filtering andrectification can be done via software on either measurement device 200as shown in FIG. 6, or on computing device 300 as shown in FIG. 8. Insome embodiments, the analysis and characterization of a swallow eventof a patient can be done entirely on the measurement device 200,entirely on the computing device 300 or shared between both of thesedevices.

Referring again to FIG. 1A, in some embodiments, measurement device 200can send sEMG signals to computing device 300; computing device 300 andclinical site 600 can be connected to data warehouse 500; andcommunications network 400 can comprise any combination of wirelessand/or wired communication media as well known to those skilled in theart. In some embodiments, communication network 400 can compriserouters, switches, base stations or any other equipment well known tothose skilled in the art that can facilitate communication betweenvarious devices and sites. In some embodiments, communication network400 can form part of a packet-based network, such as a local areanetwork, a wide-area network or a global network such as the Internet.In some embodiments, communication network 400 can operate according toone or more communication protocols, such as, for example, a GlobalSystem Mobile Communications (“GSM”) standard, a long term evolution(“4G LIE”) standard, a Worldwide Interoperability for Microwave Access(“WiMAX”) standard, a Evolved High-Speed Packet Access (“HSPA+”), a codedivision multiple access (“CDMA”) standard, a 3rd Generation PartnershipProject (“3GPP”) standard, an Internet Protocol (“IP”) standard, aWireless Application Protocol (“WAP”) standard, and/or an IEEE standard,such as, one or more of the 802.11 standards, as well as variouscombinations thereof.

FIG. 8 is a block diagram illustrating one embodiment of computingdevice 300 that can implement one or more techniques of this disclosure.In some embodiments, computing device 300 can be configured to transmitdata to and receive data from data warehouse 500 and execute one or moreapplications (for example, swallowing diagnosis and treatmentapplication 316). In some embodiments, computing device 300 cancomprise, or be part of, a portable computing device (e.g., a mobilephone, smart phone, netbook, laptop, personal data assistant (“PDA”)),or tablet device or a stationary computer (e.g., a desktop computer, orset-top box or any other computing device as well known to those skilledin the art. In some embodiments, computing device 300 can compriseprocessor(s) 302, memory 304, input device(s) 306, output device(s) 308,network interface 310 and wireless transceiver 311. In some embodiments,each of processor(s) 302, memory 304, input device(s) 306, outputdevice(s) 308, network interface 310 and wireless transceiver 311 can beinterconnected (physically, communicatively, and/or operatively) forinter-component communications. In some embodiments, operating system312, applications 314 and swallowing diagnosis and treatment application316 can be executed by computing device 300. It should be noted thatalthough computing device 300, as shown in FIG. 8, is illustrated ashaving distinct functional blocks, such this illustration is fordescriptive purposes only, and does not limit computing device 300 toany particular hardware architecture. The functions of computing device300 can be realized using any combination of hardware, firmware and/orsoftware implementations as well known to those skilled in the art.

In some embodiments, processor(s) 302 can be configured to implementfunctionality and/or process instructions for execution in computingdevice 300. In some embodiments, processor(s) 302 can be capable ofretrieving and processing instructions, code, and/or data structures forimplementing one or more of the techniques described herein.Instructions can be stored on a computer readable medium, such as memory304. In some embodiments, processor(s) 302 can comprise digital signalprocessors (“DSPs”), general purpose microprocessors, applicationspecific integrated circuits (“ASICs”), field programmable logic arrays(“FPGAs”) or other equivalent integrated or discrete logic circuitry aswell known to those skilled in the art.

In some embodiments, memory 304 can be configured to store informationthat can be used by computing device 300 during operation. Memory 304can comprise a non-transitory or tangible computer-readable storagemedium. In some embodiments, memory 304 can provide temporary memoryand/or long-term storage. In some embodiments, memory 304 or portionthereof can comprise volatile memory, that is, in some cases; memory 304may not maintain stored contents when computing device 300 is powereddown. Examples of volatile memories can include random access memories(“RAM”), dynamic random access memories (“DRAM”) and static randomaccess memories (“SRAM”). Memory 304 can be comprised as internal orexternal memory and, in some embodiments, can comprise non-volatilestorage elements. Examples of such non-volatile storage elements caninclude magnetic hard discs, optical discs, floppy discs, flashmemories, forms of electrically programmable memories (“EPROM”) orelectrically erasable and programmable (“EEPROM”) memories and othernon-volatile storage elements as well known to those skilled in the art.

In some embodiments, input device(s) 306 can be configured to receiveinput from user operating computing device 300. Input from a user can begenerated as part of the user running one or more software applications,such as swallowing diagnosis and treatment application 316. In someembodiments, input device(s) 306 can comprise a touch-sensitive screen,a track pad, a track point, a mouse, a keyboard, a microphone, a videocamera, or any other type of device configured to receive input from auser as well known to those skilled in the art.

In some embodiments, output device(s) 308 can be configured to provideoutput to user operating computing device 300. Output can comprisetactile, audio or visual output generated as part of a user running oneor more software applications, such as swallowing diagnosis andtreatment application 316. In some embodiments, output device(s) 308 cancomprise a touch-sensitive screen, sound card, a video graphics adaptercard or any other type of device for converting a signal into anappropriate form understandable to humans or machines as well known tothose skilled in the art. Additional examples of output device(s) 308can comprise a speaker, a cathode ray tube (“CRT”) monitor, a liquidcrystal display (“LCD”) or any other type of device that can provideaudio or visual output to a user as well known to those skilled in theart. In some embodiments where computing device 300 comprises a mobiledevice, output device(s) 308 can comprise an LCD or organic lightemitting diode (“OLED”) display configured to receive user touch inputs,such as, for example, taps, drags and pinches as well known to thoseskilled in the art.

In some embodiments, network interface 310 can be configured to enablecomputing device 300 to communicate with external devices via one ormore networks, such as communications network 400. Network interface 310can comprise a network interface card, such as an Ethernet card, anoptical transceiver, a radio frequency transceiver or any other type ofdevice that can send and receive information as well known to thoseskilled in the art. In some embodiments, network interface 310 can beconfigured to operate according to one or more of the communicationprotocols described above with respect to communications network 400. Insome embodiments, network interface 310 can enable a patient computingdevice running swallowing diagnostic and treatment application 316 totransmit information to clinical site 600 or to data warehouse andonline clinician portal 500. In some embodiments, clinical site 600 cancomprise a server. In some embodiments, the data can be disposed in thedata warehouse and online clinician portal 500 with the clinician at theclinical site 600 accessing a patient's data using a web browser throughthe World Wide Web. In some embodiments, wireless transceiver 311 cancomprise a wireless transceiver configured to send and receive data toand/or from measurement device 200. In some embodiments, wirelesstransceiver 311 and network interface 310 can be integrated. In someembodiments, the data can be encrypted before transmission to clinicalsite 600 or to data warehouse and online clinician portal 500. Thisencryption can comprise use any number of different encryptiontechnologies such as, but not limited to, Advance Encryption Standard(“AES”), Transport Layer Security (“TLS”) or its predecessor, SecureSockets Layer (“SSL”), RSA, Secure Shell (“SSH”), Data EncryptionStandard (“DES”) and any other equivalent encryption technology as wellknown to those skilled in the art. The encryption and decryption of datacan be done by swallowing diagnostic and treatment application 316, byoperating system 312 or by integrated circuits and processor(s) 302 at ahardware level that compose computing device 300.

In some embodiments, operating system 312 can be configured tofacilitate the interaction of applications, such as applications 314 andswallowing diagnosis and treatment application 316, with processor(s)302, memory 304, input device(s) 306, output device(s) 308, networkinterface 310, and wireless transceiver 311 of computing device 300. Insome embodiments, operating system 312 can be an operating systemdesigned to be installed on laptops and desktops. For example, operatingsystem 312 can comprise a Windows™ operating system, Linux® or Mac OS™.In embodiments where computing device 300 comprises a mobile device,such as a smartphone or a tablet, operating system 312 can be one ofAndroid™, iOS™ and Windows™ mobile operating system.

In some embodiments, applications 314 can comprise any applicationsimplemented within or executed by computing device 300 and can beimplemented or contained within, operable by, executed by, and/or beoperatively/communicatively coupled to components of computing device300. In some embodiments, applications 314 can comprise instructionsthat can cause processor(s) 302 of computing device 300 to performparticular functions. In some embodiments, applications 314 can comprisealgorithms that are expressed in computer programming statements, suchas: for loops, while-loops, if-statements, do-loops, etc. In someembodiments, applications can be developed using a programming language.Examples of programming languages can comprise Hypertext Markup Language(“HTML”), Dynamic HTML, Extensible Markup Language (“XML”), ExtensibleStylesheet Language (“XSL”), Document Style Semantics and SpecificationLanguage (“DSSSL”), Cascading Style Sheets (“CSS”), SynchronizedMultimedia Integration Language (“SMIL”), Wireless Markup Language(“WML”), Java™, Jini™, C, C++, Objective C, C#, Perin®, Python™, UNIX™Shell, Visual Basic™ or Visual Basic™ Script, Virtual Reality MarkupLanguage (“VRML”) and ColdFusion™ as well as other compilers, assemblersand interpreters as well known to those skilled in the art.

In some embodiments, swallowing diagnosis and treatment application 316can comprise an application configured to diagnose and treat aswallowing disorder according to the techniques described herein. FIG. 9is a conceptual diagram illustrating an embodiment of swallowingdiagnosis and treatment application 316. As illustrated in FIG. 8,swallowing diagnosis and treatment application 316 can compriseinterface module 352, analysis module 362, training phase module 354,calibration module 356, game module 358 and transmission module 360. Insome embodiments, these modules illustrated in FIG. 9 can comprisesoftware modules and/or can be implemented using any combination ofhardware, software or firmware as well known to those skilled in theart. In some embodiments, the modules illustrated in FIG. 9 can comprisesoftware stored locally on computing device 300. In other embodiments,the modules illustrated in FIG. 9 can comprise software modules and/orportions thereof distributed throughout system 100.

FIG. 9 illustrates a conceptual diagram of an example operation of anapplication for treating and diagnosing a swallowing disorder inaccordance with one or more techniques of this disclosure. In someembodiments, interface module 352 can be configured to generategraphical user interfaces. In some embodiments, training phase module354 can be configured to achieve the functions associated with firstvisit training phase. In some embodiments, calibration module 356 can beconfigured to achieve the functions associated with warm-up andself-calibration phase. In some embodiments, the warm-up phase can tellthe user if the sensor is applied incorrectly. In some embodiments, theself-calibration phase can record typical swallows for the patient onany one particular day and use this data to set a target exertion forthe data. In some embodiments, analysis module 362 can analyze the realtime data gathered from the patient to detect, using an algorithm, andvarious parameters for each swallowing exercise. In some embodiments,this algorithm can combine a number of analysis techniques in both thetime and frequency domain to detect swallowing characteristics as wellknown to those skilled in the art. In some embodiments, game module 358can be configured to use the outputs of analysis module 362 to achievethe functions associated with a game, and/or full training mode, and/orto display the signal to the patient as visual feedback.

In some embodiments, transmission module 360 can be configured totransmit data to either clinical site 600 or to data warehouse andonline clinician portal 500. In some embodiments, anonymized or one wayidentifiable home practice data can be sent to a central server so thatthe clinician can monitor progress and change the course of therapy, ifnecessary. In some embodiments, one or more of the following metrics canbe collected and saved at clinical site: (1) time of log-in; (2)duration of session; (3) length of time since last session; (4)session's target amplitude (μV); (5) type of exercise practiced andnumber of trials; (6) amplitude (μV) and duration (s) for each trial;(7) average (μV); duration (s) average and range for each type ofexercise; (8) comments made by patient; (9) outputs of the swallowingdetection and characterization algorithm 362; and (10) daily percent oftrials completed from those prescribed, as a metric of adherence. Thesemeasurements can be communicated to the clinician at the end of eachpractice; as well, longitudinal analysis over multiple sessions canenable assessment of patient progress over time.

In some embodiments, at the start of every session, a calibration stepcan take place where rest and normal swallows are recorded. The softwarecan then calculate the average and range signal amplitude across aninitial number of normal swallows. In some embodiments, this initialcalibration step can yield the daily targets for the practice following.In some embodiments, the training software can be gamified, meaning thatgame concepts and design can be used to engage patients and achievemaximal effort. In some embodiments, game concepts can compriserealistic graphics instead of childish ones, levels denoting progress tosingular tasks, and feedback relevant to swallowing rather than to thegame goals. In some embodiments, swallowing diagnosis and treatmentapplication 316 comprise practice reminders and progress bars as goalsetting.

In some embodiments, the application can connect to the scheduler ornotification section of computing device (300) and can further schedulean alarm, notification or message to trigger on their device when thepatient is to do their exercises. In some embodiments, the alarm,message or notification can be scheduled using an external device,server or third party service to provide the trigger for the patient todo their exercises.

In some embodiments, swallowing diagnosis and treatment application 316can comprise a fishing game where the depth travelled by the lure iscontingent on the duration of submental muscle contraction at or above30% of the daily target amplitude. The longer the contraction, thedeeper the lure travels and the more fish the player is likely to catch.In some embodiments, swallowing diagnosis and treatment application 316can comprise providing feedback based on auditory or visual stimulusthat gets more intense as the patient exerts energy to complete theexercise and then returns to a steady state when the patient completesthe exercise. The intensity of this stimulus can be proportional to theintensity of the patient's exertion. In some embodiments, swallowingdiagnosis and treatment application 316 can use various aspects of thefeedback data to accomplish a progressive task that builds on the lasttask or on many of the tasks before it to provide an interestingexperience for the user.

In some embodiments, swallowing diagnosis and treatment application 316can calibrate the practice targets according to the patient's dailyswallowing ability, thereby avoiding frustration if an arbitrary targetis not met. Further, in some embodiments, patients can practice withregular swallows if swallowing exercises are too difficult orcontra-indicated. In some embodiments, trials can be summarized at theend of practice, displayed and compared to previous sessions. This way,the patient can receive quick feedback on whether or not he/she isimproving in their practice. In some embodiments, swallowing diagnosisand treatment application 316 can walk patients through device set-up,thereby providing another level of assurance. Further, a clinician mayspend the first therapy session in the clinic, training the patient onthe use of the device and application, prior to home treatment. Theclinician then will remotely-monitor home practice.

In some embodiments, the functions described can be implemented inhardware, software, firmware or any combination thereof as well known tothose skilled in the art. If implemented in software, the functions canbe stored on, or transmitted over, as one or more instructions or code,a computer-readable medium and executed by a hardware-based processingunit. In some embodiments, computer-readable media can comprisecomputer-readable storage media, which corresponds to a tangible mediumsuch as data storage media or communication media including any mediumthat facilitates transfer of a computer program from one place toanother, e.g., according to a communication protocol as well known tothose skilled in the art. In this manner, computer-readable mediagenerally can correspond to: (1) tangible computer-readable storagemedia which is non-transitory; or (2) a communication medium such as asignal or carrier wave. Data storage media can comprise any availablemedia that can be accessed by one or more computers or one or moreprocessors to retrieve instructions, code and/or data structures forimplementation of the techniques described in this disclosure as wellknown to those skilled in the art. A computer program product cancomprise a computer-readable medium.

By way of example, and not limitation, in some embodiments, suchcomputer-readable storage media can comprise RAM, ROM, EEPROM, CD-ROM orother optical disk storage, magnetic disk storage, or other magneticstorage devices, flash memory or any other medium that can be used tostore desired program code in the form of instructions or datastructures and that can be accessed by a computer as well known to thoseskilled in the art. Also, any connection can be properly termed acomputer-readable medium. In some embodiments, if instructions aretransmitted from a website, server, or other remote source using acoaxial cable, fiber optic cable, twisted pair, digital subscriber line(“DSL”) or wireless technologies such as infrared, radio, and microwave,then the coaxial cable, fiber optic cable, twisted pair, DSL, orwireless technologies such as infrared, radio, and microwave can beincluded in the definition of medium. It should be understood, however,that computer-readable storage media and data storage media do notinclude connections, carrier waves, signals, or other transient media,but are instead directed to non-transient, tangible storage media. Diskand disc, as used herein, includes compact disc (“CD”), laser disc,optical disc, digital versatile disc (“DVD”), floppy disk and Blu-raydisc, where disks usually reproduce data magnetically, while discsreproduce data optically with lasers. Combinations of the above shouldalso be included within the scope of computer-readable media.

In some embodiments, instructions can be executed by one or moreprocessors, such as one or more digital signal processors (“DSPs”),general purpose microprocessors, application specific integratedcircuits (“ASICs”), field programmable logic arrays (“FPGAs”) or otherequivalent integrated or discrete logic circuitry as well known to thoseskilled in the art. Accordingly, the term “processor,” as used hereincan refer to any of the foregoing structure or any other structuresuitable for implementation of the techniques described herein. Inaddition, in some embodiments, the functionality described herein can beprovided within dedicated hardware and/or software modules as well knownto those skilled in the art. Also, the techniques can be fullyimplemented in one or more circuits or logic elements.

In some embodiments, the techniques of this disclosure can beimplemented in a wide variety of devices or apparatuses, including awireless handset, an integrated circuit (“IC”) or a set of ICs (e.g., achip set). Various components, modules or units as described in thisdisclosure emphasize functional aspects of devices configured to performthe disclosed techniques, but do not necessarily require realization bydifferent hardware units. Rather, as described above, various units canbe combined in a codec hardware unit or can be provided by a collectionof inter-operative hardware units, including one or more processors asdescribed above, in conjunction with suitable software and/or firmwareas well known to those skilled in the art.

Although a few embodiments have been shown and described, it will beappreciated by those skilled in the art that various changes andmodifications can be made to these embodiments without changing ordeparting from their scope, intent or functionality. The terms andexpressions used in the preceding specification have been used herein asterms of description and not of limitation, and there is no intention inthe use of such terms and expressions of excluding equivalents of thefeatures shown and described or portions thereof, it being recognizedthat the invention is defined and limited only by the claims thatfollow.

What is claimed is:
 1. A method of providing sensory feedback during anexercise, the method comprising: setting an exertion target, for a userperforming the exercise, based on a self-calibration that estimates theuser's ability using signal amplitudes of surface electromyography(sEMG) data, wherein the exertion target includes a target signalamplitude of muscle contractions to be reached during the exercise;receiving sEMG data from a measurement device attached to the user asthe user performs the exercise; and upon processing the sEMG data,generating sensory feedback at a computing device operated by the user,wherein the sensory feedback has an intensity proportional to the user'sexertion level as the user performs the exercise, and wherein thesensory feedback changes over a course of the exercise in dependence ona duration that the user maintains a muscle contraction at or above thetarget signal amplitude, and the change in sensory feedback isconfigured to encourage the user to prolong the duration.
 2. The methodof claim 1, wherein the sensory feedback is responsive to the durationthat a muscle contraction is maintained at or above a pre-definedquantum higher than the target signal amplitude.
 3. The method of claim1, wherein the sensory feedback includes audible feedback.
 4. The methodof claim 1, wherein the sensory feedback includes visual feedback. 5.The method of claim 4, further comprising: generating a graphical userinterface for presentation of the visual feedback.
 6. The method ofclaim 1, wherein the sensory feedback provides an indication of themuscle contraction to the user.
 7. The method of claim 6, wherein theindication includes an indication of a duration of the musclecontraction.
 8. The method of claim 1, wherein the sensory feedback ispresented in a form of a game playable by the user.
 9. The method ofclaim 8, further comprising: controlling functions of the game based onsaid processing the sEMG data.
 10. The method of claim 1, furthercomprising: computing an average and a range of the signal amplitudesreceived for the self-calibration.
 11. The method of claim 1, whereinthe self-calibration estimates the patient's ability for a particularday to set at least one of the exertion targets for the exercises of theparticular day.
 12. The method of claim 1, wherein the self-calibrationestimates the patient's ability for a particular exercise session to setat least one of the exertion targets for the exercises of the particularexercise session.
 13. A computer-implemented device for providingsensory feedback during an exercise, the device including: acommunication interface; at least one processor; memory in communicationwith the at least one processor, and software code stored in the memory,which when executed by the at least one processor causes the device to:set an exertion target, for a user performing the exercise, based on aself-calibration that estimates the user's ability using signalamplitudes of surface electromyography (sEMG) data, wherein the exertiontarget includes a target signal amplitude of muscle contractions to bereached during the exercise; receive, via the communication interface,sEMG data from a measurement device attached to the user as the userperforms the exercise; and upon processing the sEMG data, generatesensory feedback that has an intensity proportional to the user'sexertion level as the user performs the exercise, and wherein thesensory feedback changes over a course of the exercise in dependence ona duration that the user maintains a muscle contraction at or above thetarget signal amplitude, and the change in sensory feedback isconfigured to encourage the user to prolong the duration.
 14. Thecomputer-implemented device of claim 13, wherein the communicationinterface is configured for wireless communication with the measurementdevice.
 15. The computer-implemented device of claim 13, wherein thewireless communication includes Bluetooth communication.
 16. Thecomputer-implemented device of claim 13, wherein the sensory feedback isresponsive to the duration that a muscle contraction is maintained at orabove a pre-defined quantum higher than the target signal amplitude. 17.The computer-implemented device of claim 13, wherein the sensoryfeedback includes audible feedback.
 18. The computer-implemented deviceof claim 13, wherein the sensory feedback includes visual feedback. 19.The computer-implemented device of claim 13, wherein the device is aportable computing device.
 20. A non-transitory computer-readable mediumhaving stored thereon machine interpretable instructions which, whenexecuted by a processor, cause the processor to perform a computerimplemented method for providing sensory feedback during an exercise,the method including: setting an exertion target, for a user performingthe exercise, based on a self-calibration that estimates the user'sability using signal amplitudes of surface electromyography (sEMG) data,wherein the exertion target includes a target signal amplitude of musclecontractions to be reached during the exercise; receiving sEMG data froma measurement device attached to the user as the user performs theexercise; and upon processing the sEMG data, generating sensory feedbackthat has an intensity proportional to the user's exertion level as theuser performs the exercise, and wherein the sensory feedback changesover a course of the exercise in dependence on a duration that the usermaintains a muscle contraction at or above the target signal amplitude,and the change in sensory feedback is configured to encourage the userto prolong the duration.